Author Topic: Newbie with Low T  (Read 712 times)

Ashto70

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Re: Newbie with Low T
« Reply #15 on: December 08, 2017, 07:43:07 PM »
Hi Andy

I just want to get the quick advisory out of the way first: the forum doesn't condone self-medicating and neither does it condone or encourage the discontinuation of any prescribed medicines. We strongly advise our members to consult and work with their health-provider at all times.

Now that bit is out of the way I want to offer you my personal thoughts and experience. I've been on Sertraline for many years. I began with Paroxetine around mid-2000 when I first started to experience symptoms of testicular cancer and low testosterone. My testosterone therapy didn't start until 2002 and I felt like a million dollars for months. It seemed like the combination of SSRI and testosterone was raising my mood and my libido, or at least compensating for some of the libido lost to the effects of the antidepressants.

SSRI withdrawals can be intense, even if you intend to wean yourself off them. If you've not been on SSRI for more than a year your ride might not be so bad. If you've been on them long-term then you risk suffering a fair bit more. It's highly plausible to believe your libido will increase significantly over the reduction period, but my concern is that the testosterone alone will not compensate fully for the loss of dopamine and serotonin the SSRI were providing. In short, I'm saying that if you suffer from chronic low mood and depression testosterone probably won't fill the gap.

On the contrary though, if the reason for your depression was largely - or preferably entirely - owing to low testosterone then you may be onto a winner. I think the message from me is to exercise caution and don't expect anything extraordinarily fantastic in the way of results.

Best of luck and keep us informed.
Craig   

Olly13

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Re: Newbie with Low T
« Reply #16 on: December 08, 2017, 08:27:53 PM »
To add to what Craig has written better than myself, you might actually be better off waiting another 6-8 weeks for the TRT to even start doing anything at all. Especially given the fact that you are on Nebido, after that then consider discontinuation of the SSRIs. (preferably under medical supervision)

SSRI withdrawals can be intense, even if you intend to wean yourself off them. If you've not been on SSRI for more than a year your ride might not be so bad. If you've been on them long-term then you risk suffering a fair bit more. It's highly plausible to believe your libido will increase significantly over the reduction period, but my concern is that the testosterone alone will not compensate fully for the loss of dopamine and serotonin the SSRI were providing. In short, I'm saying that if you suffer from chronic low mood and depression testosterone probably won't fill the gap.

SSRIs don't generally increase dopamine, at all. If anything the older SSRIs can potentially lower dopamine.

however I totally get your point nevertheless and agree as a whole. :)

*EDIT* actually your right to a degree, sertraline (and only sertraline) as an SSRI has the potential to inhibit dopamine reuptake. I'll shut up now I've corrected myself...

This might be why sertraline is commonly seen as the least damaging lebido wise, as you've also said in the past. The more you know eh.
« Last Edit: December 08, 2017, 08:38:12 PM by Olly13 »

andy

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Re: Newbie with Low T
« Reply #17 on: December 08, 2017, 08:45:00 PM »
Thanks Olly and Craig for your replies.

I originally started taking sertraline last year after consulting with my GP. This was 12 months before my diagnosis of Low T, although I now think it had started to drop then, maybe as long as 3 years ago.

It was suggested by my GP last year for me to gradually reduce the dosage if and when I wanted to. I gradually withdrew then with no side effects at all. This year I have only been taking sertraline for the last 8 weeks. My GP decided to leave it on my repeat prescription options to order if I wanted it again within 12 months of coming off it last time. I have never suffered from depression so I guess I don't get the bad withdrawal effects which some people can get. But if I do start to experience any unpleasant withdrawal symptoms and feel I need to increase to the usual dosage I have plenty of tablets left, enough until early January in fact. I have never been on any more than 50mg a day which I think is a fairly low dose.

I do indeed think my issues have been entirely due to the low T. I went back on sertraline 8 weeks ago because my mood felt low and concentration was poor. As neither significantly increased by taking sertraline and neither decreased when I came off it, it leads me to think low T is the sole cause of everything. As i mentioned in a previous post I have never suffered any mental health issues in the past.

I also don't want the sertraline to dampen down any positive effects from nebido, either in the short term or long term. I am not expecting any immediate dramatic effect from the nebido, although of course I am hoping to experience at least something by the time I've had 2 or 3 injections. An increase in libido and a decrease in brain fog by then would be brilliant but I am keeping my expectations realistic.

Ashto70

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Re: Newbie with Low T
« Reply #18 on: December 09, 2017, 12:01:14 PM »
Hi, gents.

Interesting factual nugget there Ollie; I was under the impression all SSRI's worked by increasing levels of dopamine. Although I take SSRI's I know practically zilch about their actual neurological function and mechanics. I thought they basically all did the same thing!

Okay, Andy. I think you know what you're doing and since you've only been on Sertraline again for two months I doubt a gradual reduction is over a few weeks is going to have any great impact on your well-being. I just hope the Nebido works for you bro. It's a shame that the gels didn't have the desired effect. However, I'm surprised your doctor decided they weren't working at one sachet. What was his reason for discontinuing rather than increasing the dose?

It doesn't matter anyway as that's all in the past. Fingers crossed the Nebido works for you bro. Even if that doesn't it's still not the end of the road. I'm on Sustanon 250 injections (250mg every 12 to 16 days). Sustanon, I'd say, is the middle ground and probably the most potent of all the options available. It's so damn cheap too, and I can't believe more doctors don't prescribe it.

Looking forward to hearing how you get on with this bro. Please keep us informed.
Craig

andy

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Re: Newbie with Low T
« Reply #19 on: December 09, 2017, 02:45:43 PM »
It's a shame that the gels didn't have the desired effect. However, I'm surprised your doctor decided they weren't working at one sachet. What was his reason for discontinuing rather than increasing the dose?


I used one sachet of Testogel from end of June until last week when I started Nebido. For the first month I did feel there was some improvement in both mood and libido. But by August I felt my T had dropped low again. A blood test on Aug 7th showed it was 8.5. The next one on Oct 10th showed it at 6.6 so a further drop. It was because I felt so bad in October I restarted the sertraline.

When I saw the endo at the end of October he said I could either try 2 sachets of testogel or start nebido injections. I went for nebido, as to be honest by then I had very little confidence in the Testogel. My T was dropping further while using the Testogel rather than increasing.
 
If Testogel had raised T levels a little and I simply needed a bit more dose to increase levels further then I would have tried using 2 sachets.

Re nebido....time will tell!! 


andy

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Re: Newbie with Low T
« Reply #20 on: December 13, 2017, 08:40:42 PM »
I have today got a printout from my GP surgery of the blood tests I had on 7th Aug and 10th Oct, when I was using Testogel, the first was done after 6 weeks on Testogel, the second after 3 1/2 months of using it. While I enquired about my testosterone levels at the time (8.5 in Aug and 6.6 in Oct) I had never enquired what other things were tested and what the results are.

The good news is my PSA was tested in October and was 0.75 ug/L which from what I understand is a good level, meaning I am not in any short term risk of developing prostate cancer. The endo had said TRT can be dangerous if PSA is high.

Also good to see were my Haemotocrit, Haemogloblin and SHBG levels were all normal and virtually identical to the blood test done in May before I started Testogel. Although this is leading me to believe my body wasn't properly absorbing the Testogel.

However, I was disappointed to see my LH, FSH, Cortisol and Oestradiol levels had not been tested at all on either of the blood tests. Am I right in thinking these should all be tested during all blood tests when on TRT?

I know my cortisol levels are fine as the endo wrote to me to tell me after I had the adrenal test last month, so I'm not concerened about this at all. But I haven't the faintest idea what my LH and FSH did when I was on Testogel. I know they were perfectly normal before I started. I assume if it had worked well then those levels would have dropped. But my T levels didn't rise, in fact they dropped while on Testogel.

I have since then had 2 blood tests at the hospital, arranged by my endo, the second one on the day I had my first nebido injection 2 weeks ago. So I am hoping the hospital know what they are doing and test all the relevant things to monitor what changes while on nebido.


« Last Edit: December 13, 2017, 08:47:19 PM by andy »

Sham

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Re: Newbie with Low T
« Reply #21 on: December 13, 2017, 08:48:43 PM »
There is no point in testing LH and FSH when you are on TRT as they will usually be close to zero. The NHS does not routinely test oestradiol, and there is normally no reason to regularly test cortisol when on TRT (it is of limited relevence). You can do a blood test privately if you are interested in knowing those results, but the NHS is looking to save money so will usually not do anything unless absolutely necessary.

andy

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Re: Newbie with Low T
« Reply #22 on: December 15, 2017, 03:06:26 PM »
There is no point in testing LH and FSH when you are on TRT as they will usually be close to zero. The NHS does not routinely test oestradiol, and there is normally no reason to regularly test cortisol when on TRT (it is of limited relevence). You can do a blood test privately if you are interested in knowing those results, but the NHS is looking to save money so will usually not do anything unless absolutely necessary.


Fair point. However I have today got the results of my 2 most recent blood tests done on 31st Oct and 30th Nov while I was still on Testogel, before I started Nebido. I am now totally confused by the results especially regarding LH and FSH which people say should drop dramatically while on TRT and sometimes go down to almost zero. They are virtually identical to the blood test before I started TRT.

13th June (before starting TRT):
Testosterone 6.7
LH 3.4
FSH 2.2

7th Aug (6 weeks on Testogel):
Testosterone 8.5
LH and FSH not tested

10th Oct (3 1/2 months on Testogel):
Testosterone 6.6
LH and FSH not tested

31st Oct (after 4 months of Testogel):
Testosterone 5.6
LH 3.0
FSH 2.3

30th Nov (after 5 months of Testogel):
Testosterone 5.4
LH 3.0
FSH 2.4

Does this mean my body wasn't absorbing any of the Testogel? With falling testosterone levels alongside LH and FSH which didn't drop at all I cannot think of any other explanation. If that is the case I just hope Nebido does a better job.


Sham

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Re: Newbie with Low T
« Reply #23 on: December 15, 2017, 03:37:06 PM »
It looks like your body was not absorbing any! Quite unusual. This may indicate a thyroid issue.

andy

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Re: Newbie with Low T
« Reply #24 on: December 15, 2017, 05:04:10 PM »
It looks like your body was not absorbing any! Quite unusual. This may indicate a thyroid issue.

It's frustrating! The nurse who I spoke to on the phone at the endocrinology department today simply said my LH and FSH levels were perfectly normal and well within range so no further action is required. She said the only abnormality was the low testosterone which should rise now I'm on nebido. If TRT is meant to significantly lower LH and FSH surely she should know this, being an endocrinology specialist nurse?

My thyroid was checked 6 months ago when I first went to the doctor saying I didn't feel well and thought I may have low T.
My TSH (thyroid stimulating hormone) was 1.2 then, which I was told shows perfectly normal thyroid function. Although I guess there is a chance something could have gone wrong with my thyroid in the last few months. My mum has had an overactive thyroid for many years and takes medication to control it. She says the first sign when something is amiss with the thyroid is weight loss (overactive thyroid) or weight gain (underactive thyroid). I haven't noticed any change in my weight.

I suppose I've just got to put it down to my body not absorbing the Testogel. As I'm now on Nebido hopefully my body will absorb that better. From what I've read it is absorbed a completely different way than gels.

Olly13

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Re: Newbie with Low T
« Reply #25 on: December 15, 2017, 07:00:42 PM »
It's frustrating! The nurse who I spoke to on the phone at the endocrinology department today simply said my LH and FSH levels were perfectly normal and well within range so no further action is required. She said the only abnormality was the low testosterone which should rise now I'm on nebido. If TRT is meant to significantly lower LH and FSH surely she should know this, being an endocrinology specialist nurse?

My thyroid was checked 6 months ago when I first went to the doctor saying I didn't feel well and thought I may have low T.
My TSH (thyroid stimulating hormone) was 1.2 then, which I was told shows perfectly normal thyroid function. Although I guess there is a chance something could have gone wrong with my thyroid in the last few months. My mum has had an overactive thyroid for many years and takes medication to control it. She says the first sign when something is amiss with the thyroid is weight loss (overactive thyroid) or weight gain (underactive thyroid). I haven't noticed any change in my weight.

I suppose I've just got to put it down to my body not absorbing the Testogel. As I'm now on Nebido hopefully my body will absorb that better. From what I've read it is absorbed a completely different way than gels.


Correct, Nebido is absorbed totally differently to gels, fortunately for you.

Some people just don't do well with gels, don't worry.

I wouldn't count on an Endocrinologist Nurse knowing that TRT will lower LH and FSH, welcome to the mess which is TRT at this current time, in 20-30 years we'll all be laughing hopefully.
« Last Edit: December 15, 2017, 07:04:08 PM by Olly13 »

Sham

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Re: Newbie with Low T
« Reply #26 on: December 15, 2017, 07:02:06 PM »
The nurse SHOULD know, but like so many other Ďprofessionalsí treating hypogonadism, there is massive lack of knowledge and experience. I am sadly not surprised. Many of the endocrinologists are not much better. Thatís why forums like this are so important - it is often the only way you will hear from people who know what they are talking about.

A TSH of 1.2 looks fine, but must be interpreted in conjuction with at least the thyroid hormones T4 and T3. Alone it does not tell the whole story. Strange situation though with you not absorbing at all.

You should do better with Nebido.

Olly13

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Re: Newbie with Low T
« Reply #27 on: December 15, 2017, 07:09:57 PM »
The nurse SHOULD know, but like so many other Ďprofessionalsí treating hypogonadism, there is massive lack of knowledge and experience. I am sadly not surprised. Many of the endocrinologists are not much better. Thatís why forums like this are so important - it is often the only way you will hear from people who know what they are talking about.

A TSH of 1.2 looks fine, but must be interpreted in conjuction with at least the thyroid hormones T4 and T3. Alone it does not tell the whole story. Strange situation though with you not absorbing at all.

You should do better with Nebido.

This is what drives my passion to keep doing what I'm doing, it's unbelievable that stuff like this is still happening.

Take my story for example, I went through hoops to get TRT and even then had to pay privately to get help, I thought I was genuinely better of dead at one point, not to sound drastic or anything but the lack of support I got lead me down that road mentally, not to mention all the teen years unknowing suffering from this.

The even sadder thing is my story is not the worst by far, I've seen so much misery written it's horrible.

andy

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Re: Newbie with Low T
« Reply #28 on: December 15, 2017, 07:29:46 PM »
It really does now look like the Testogel didn't just not do much, it didn't actually do anything!!

If I'd had LH and FSH tested in August and October when I had the blood tests this fact may have been discovered much earlier. It certainly explains why I have felt so bad for so long. Anyway I suppose there is no point dwelling on the past. I'm not on Testogel any more, I'm on nebido now, so I am very intrigued to see what the next blood test shows, which I will have on the day I have the next injection (6 weeks after the first). I'm going to check then they are testing LH and FSH as well as Testosterone. I've still not had oestradiol checked on any of the blood tests so I shall remind them about that too, in case I'm converting too much testosterone. I'm now 2 weeks since the first jab and there's certainly no sign of any positive changes yet, but I know I have to be patient.

I do indeed share other's frustration with the NHS in dealing with hypogonadism. I have come to the conclusion no one else is going to sort my hypogonadism out for me, I need to sort it out myself! Thanks guys for your input and advice, I appreciate you taking the time. There is far more knowledge on this forum than I have got from the NHS.
« Last Edit: December 15, 2017, 07:31:42 PM by andy »

Sham

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Re: Newbie with Low T
« Reply #29 on: December 15, 2017, 07:53:06 PM »
I have come to the conclusion no one else is going to sort my hypogonadism out for me, I need to sort it out myself! Thanks guys for your input and advice, I appreciate you taking the time. There is far more knowledge on this forum than I have got from the NHS.

I came to that conclusion a while back. Thatís why I self-medicate.